For Teenage Smokers, Removing the Allure of the Pack
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Wednesday, August 1, 2012 | Tina Rosenberg | Categories:
Remember teenage smoking? It’s been edged out by teenage obesity as the health concern of the moment. States are cutting programs to prevent the former while establishing programs to combat the latter. We shouldn’t forget about it. Last year, 18.7 percent of high school seniors were smokers — just about the same as the percentage of teenagers who are obese. But it may be even more important to attack teenage smoking than obesity. Fighting obesity is a lifelong battle. But for smoking, adolescence is Armageddon. Only 1 in 10 smokers starts after the age of 18. After the teenage years, the battle is lost. That’s the bad news. The good news is that unlike with obesity, we know what to do. We didn’t always know. In 1997, when 36.5 percent of high school seniors were smokers, a headline in The Washington Post said: “Officials Seek a Path to Cut Into Haze of Youth Smoking — The Bottom Line: No One Knows What Works.” Up to that point, efforts to keep teenagers away from cigarettes had focused on health. Public health officials firmly believed that once people knew about how bad smoking was for you, they wouldn’t start. But while health messages have proven good at getting adults to quit, they are not effective at keeping teenagers from starting. Any teenager could explain why. For them, a cigarette is not a delivery system for nicotine. It’s a delivery system for rebellion. Kids take up smoking to be cool, to impress their friends with their recklessness and defiance of adults. Teenagers don’t care about lung cancer — they’re immortal. They know that smoking is dangerous. In fact, they overestimate the chances of getting lung cancer. Danger is part of a cigarette’s appeal. Since 1997, we’ve learned a lot about how to prevent teenage smoking. The best strategy? Make smoking uncool. One new initiative likely to have a positive effect on both teenage and adult smoking rates will take place this year when Australia will become the first country to regulate that last bastion of cigarette advertising: the pack. All cigarette packs will look alike — a generic olive-green, with big health warnings and the brand name written in small, standardized lettering. For teenagers, who are intensely brand-conscious, plain packs will certainly take some of the allure out of smoking. Based on the reaction from the tobacco industry, this will hurt. It is waging total war in the World Trade Organization and has mounted legal challenges and information blitzes (here’s Philip Morris’s Web site opposing plain packaging). Assuming the law survives these challenges, it is likely to spread. New Zealand and Britain are also moving forward with plain packaging legislation. Indian officials have said they will introduce proposals as well. Big Tobacco is desperate because it is well aware of what worked before. The biggest drop in teenage smoking in United States history took place in Florida between 1998 and 2000, as a result of a revolutionary advertising campaign called Truth. Florida had been one of the first states to sue the tobacco companies, and won a settlement that provided the first sustained stream of money to combat teenage smoking. Then 46 states joined together to sue. As part of the larger settlement, the cigarette manufacturers had to release internal documents. These showed that tobacco companies were targeting teenagers — despite denying doing just that. California had just found success with a campaign that for the first time, portrayed the tobacco companies as the villains. Now Florida would turn that to use for teenagers. Instead of hiring an ad agency experienced with public health, Florida hired one that specialized in selling stuff, often to teenagers: Crispin Porter + Bogusky. Then it convened a teen tobacco summit. There 600 kids critiqued other states’ anti-smoking ads. “The ‘smoking will kill you,’ ‘smoking will turn your teeth yellow’ didn’t work,” said Jared Perez, a tenth-grader at the time from the Tampa Bay area, whom I interviewed in 2009 for my book “Join the Club: How Peer Pressure Can Transform the World.” “My reaction, which was typical, was that these were messages you’ve heard before.” Not so the tobacco industry documents. “These documents were something I’d never heard before,” Perez said. “It was more compelling than ‘smoking is bad for you.’ It was a truth issue.” Crispin Porter’s ad campaign took the teenage desire for rebellion and turned it against the tobacco companies. The Truth brand would now compete with Marlboro and Camel. For one TV spot, Florida teenagers taped a road trip: they drove to Philip Morris headquarters in Richmond, Va., and asked the security guard at the compound gate if they could talk to the Marlboro Man. Sorry, he’s dead, the guard replied. (The model who played the Marlboro man had indeed just died — of lung cancer.) This all went on tape and on the air. Other ads showed kids making prank phone calls to the tobacco-industrial complex. A group of girls called Lucky Strike’s advertising account coordinator. “What is the ‘lucky’ part about Lucky Strike cigarettes?” one girl asks. “Is it because… I might live?” After the executive hangs up, the girls laugh maliciously. Florida’s health department then organized SWAT — Students Working Against Tobacco — groups in every county. “We never said ‘don’t smoke,’” said Perez, who was later hired to run SWAT. “We got a bunch of kids together to make a statement to the tobacco industry — to rebel against them.” The TV ads and the student groups amplified each other. The television spots made it look like teen rebellion against cigarette companies was sweeping the state. The SWAT groups made it look like the TV ads came from kids, not adults — which boosted their credibility. When Florida started the Truth campaign, 27.4 percent of its high school students were smokers. Just two years later, that figure had fallen to 22.6 percent; the epidemiologist who evaluated the program called it “”perhaps the most effective antitobacco program in the world.” Smoking rates have continued to fall, although more slowly. Last year, 14.1 percent of Florida’s high school students smoked — about half the pre-Truth number. With money from the tobacco lawsuit settlement, the truth strategy went national. And it worked nationwide — teen smoking is now half what it was in 1997. But the decline has slowed as states have spent less and less; the vast majority of states have raided their tobacco settlement treasuries and put the money to other use. Even some states that are still spending money have forgotten what works — no doubt at the urging of Big Tobacco — and gone back to health themes. Even Florida has abandoned Truth. Its current ad campaigns feature moving portraits of a young man who died at 30 from smoking, and a girl who lost her father. The evidence of the Truth campaign’s effectiveness is now joined by evidence about two other ways to make smoking less cool. One is to keep cigarettes out of movies. There’s a reason for the sordid history of payments by tobacco manufacturers to moviemakers for product placement (which some researchers argue still goes on). When movie characters smoke, so do teenagers — among kids with nonsmoking parents, the study found that more than half of all smoking initiation comes from exposure to smoking in movies. Leonardo DiCaprio’s smoking in “The Titanic” movie will kill far more people than the 1500 who died in the ship accident. The latest study showing the impact also finds that most smoking exposure in movies comes in films rated PG-13. It concludes that if all movies with cigarette smoking were rated R — which means that no filmmaker seeking a youth audience would show it — teen smoking could drop by a whopping 18 percent. The other idea is generic cigarette packaging. We can’t be sure that plain packaging reduces teen smoking, as Australia will be the first to try it. But there’s very strong evidence that it will help. Teenagers love brands, and far more than adults, choose heavily advertised brands to smoke. In countries where cigarette advertising is heavily regulated, the job of brand promotion falls largely to the pack. It’s the channel for telling teenagers that American Spirits mark you as hip, or Camel Reds are a he-man smoke, or Virginia Slims or Capri will make you thin and glamorous. (Why do you think so many cigarettes targeting women are called “slims”?) Plain packs make the name far less prominent, and eliminate the package design that carries all these associations. Teenagers see plain packs as less attractive, and believe their cigarettes don’t taste as good. Teenagers label smokers of plain-pack cigarettes as less stylish and social. Girls said that plain-pack cigarettes were less likely to help them stay thin. Plain packaging also reduces a cigarette’s value as a social cue with peers. Every time a teenage girl takes a pack out of her purse to get a cigarette, she is flashing all those brand associations at her friends as well. In short, plain packaging erases the cool factor that comes from smoking a specific brand. A switch to plain packaging requires no outlay from the government. Nor would re-rating movies in which people smoke. Reviving the Truth campaign is another story — while the student groups such as SWAT are relatively cheap to maintain, TV ads are always costly. But if money for teenage smoking prevention is needed, it’s always available from raising cigarette taxes. As a deterrent to teenage smoking, that works, too.New York Times